‘Awakenings are rare. It is almost never possible to be this perfect in the chaos of the emergency department.
Explore This IssueACEP News: Vol 32 – No 10 – October 2013
The stars on my team were aligned and working in perfect accord.’
“Continue good compressions. It is safe,” I said. With faith in me, he maintained the rhythm, and the monitor registered excellent pulse oximetry, a marker of great CPR. The pharmacist was getting the drugs, the intern prepared for intubation. The nurses ran to get the code cart. Until the push drugs were available at the bedside, I squeezed the amiodarone bag and encouraged Frank to keep up perfect compressions. Though he must bench-press over 300 these days, the steady rhythm of much lighter pressure was exactly what this patient needed. At this moment, Frank was my best weapon and I had faith in his ability to keep the patient’s brain alive.
As two minutes passed, the equipment was assembled, and the intern got ready to intubate. As if sensing the laryngoscope approaching, the patient’s eyes opened wide and he took a spontaneous breath. We all froze in surprise, watching a ghost.
“He just got another internal shock,” Frank reported. I asked him to stop CPR. Steady rhythm on the monitor.
“Wha…wha…what happened?” the ghost asked, staring back at all of us. It was only a miracle. We did everything right, no delays, with enough amiodarone on board early enough that the internal shocks began to work. He received multiple therapies upon arrival as part of a sophisticated protocol. The telemetry did its job. Impeccable CPR perfused the brain and bought time. As if every push on the sternum added yet another month of productive life to be savored and shared.
Awakenings are rare. It is almost never possible to be this perfect in the chaos of the emergency department. The stars on my team were aligned and working in perfect accord. Losing my composure, I faced the ghost, with one question I’ve always had and only he could answer: “What did you see?”
The room was dead silent while the living centerpiece struggled with a response in front of a dozen strangers.
“Nothing … I saw nothing … I was talking to my wife, and then you were all here, just like that … What the hell happened?”
He looked incredulously around the room and smiled in disbelief.
“You died,” I said. “Welcome back. Please don’t do that again.” Somehow, blunt honesty felt appropriate. And in the room where someone just died, everyone laughed – including him.